Acute liver failure in Sweden: etiology and outcome

Abstract

Abstract. Wei G, Bergquist A, Broomé U, Lindgren S, Wallerstedt S, Almer S, Sangfelt P, Danielsson Å , Sandberg-Gertzén H, Lööf L, Prytz H, Björnsson E (Sahlgrenska University Hospital, Gothenburg; Karolinska University Hospital, Huddinge, Stockholm; University Hospital MAS, Malmö; University Hospital, Linköping; University Hospital, Uppsala; University Hospital, Umeå; University Hospital, Ö rebro; Central Hospital, Västerås; and University Hospital, Lund; Sweden). Acute liver failure in Sweden: etiology and outcome. Results. A total of 279 patients were identified. The most common cause of ALF were acetaminophen toxicity in 42% and other drugs in 15%. In 31 cases (11%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67%, negative-predictive value (NPV) of 84% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54% and 63% respectively. MELD score >30 had a positive-predictive value of 21%, negative-predictive value of 94% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64% and 76% respectively.Conclusions. Acetaminophen toxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score <30 predicts a good prognosis in acetaminophen patients without transplantation.

Clinical features and outcomes of patients with drug-induced autoimmune hepatitis: A retrospective cohort study

“…This distinction is neither useful nor feasible in the majority of cases always, due to the absence of specific useful features, as pointed out by Björnsson et al [4], Suzuki et al [1], and recently stressed by Weiler-Normann and Schramm [13]. In this setting, the criteria that argue for DI-AIH are the absence of fibrosis at histological examination and the absence of recurrence after discontinuation of immunosuppressive therapy.…”

“…It is also the principal reason of medications withdrawal from the market [2], and the most common cause of fulminant hepatic failure in both the United States and Europe [3,4]. More than 1000 different drugs and herbal products have been described as cause of DILI, with a dose-dependent, or more frequently, an idiosyncratic toxicity.…”

Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol‐induced hepatotoxicity

“…Paracetamol (acetaminophen) hepatotoxicity remains the leading cause of acute liver failure (ALF) in the UK, North America and Europe, and represents a significant healthcare burden [1][2][3]. Management of early, non-staggered, paracetamol overdose using N-acetyl cysteine (NAC) as an antidote is based upon the use of the Prescott nomogram [4], but this nomogram cannot be used in patients who have taken repeated supratherapeutic ingestions of paracetamol (staggered overdoses), and there are too few data available to conclude that it is reliable in patients who present >15 h post overdose [5].…”

Acute and chronic paracetamol overdose in paediatric population: Protocol of a prospective study of cohort to evaluate clinic factor and biomarkers to predict development of hepatotoxicity

“…In the overdose situation, it may cause hepatotoxicity and fulminant hepatic failure. It is the main drug causing acute liver failure in some countries such as the United States, United Kingdom and other European countries (1)(2)(3) . According to the report of the adverse event reporting system of FDA in the United States between 1998 and 2005, paracetamol ranked 5th among drugs suspected of causing any serious non-fatal and fatal adverse reactions (4) .…”